Impact of online patient reminders to improve asthma care: A randomized controlled trial

<div><p>Importance</p><p>Asthma is one of the most burdensome chronic illnesses in the US. Despite widespread dissemination of evidence-based guidelines, more than half of the adults with asthma have uncontrolled symptoms.</p><p>Objective</p><p>To examine the efficacy of an online tool designed to improve asthma control.</p><p>Design</p><p>12-month single blind randomized controlled trial of the online tool (Intervention condition, IC) versus an active control tool (CC).</p><p>Setting</p><p>Patients enrolled in an insurance plan.</p><p>Participants</p><p>Participants were 408 adults (21–60 years of age) with persistent asthma.</p><p>Intervention</p><p>At least once each month and before provider visits, participants in the IC answered questions online about their asthma symptoms, asthma medications and asthma care received from providers, such as an asthma management plan. The tool then provided tailored feedback to remind patients 1) to ask health care providers specific questions that may improve asthma control (e.g., additional controller medications) and 2) to consistently perform specific self-care behaviors (e.g., proper inhaler technique). Participants in the CC received similar questions and feedback, yet focused instead on preventive services unrelated to asthma control (e.g., cancer screening).</p><p>Main outcome measures</p><p>The main outcome measure was asthma control, as assessed by the 5-question Asthma Control Test (ACT). Secondary outcomes included quality of life, medication use and healthcare utilization (e.g., emergency department visits).</p><p>Results</p><p>After 12 months, 323 participants completed follow-up measures (79.2%). Participants in the IC reported a greater mean improvement in the ACT score than participants in the CC (2.3 vs. 1.2; p = 0.02) and 9 of 11 individual asthma control survey items showed non-significant improvements favoring the IC. No differences were observed in medication adherence, number of asthma controller medications or health care utilization.</p><p>Conclusion and relevance</p><p>Simple and brief online patient reminders improved asthma control among insured patients. Although future studies are needed to understand the mechanism of the improvement, the magnitude of the effect on asthma control was similar to the addition of an additional controller medication. Given the widespread use of the Internet, simple tools such as this may be useful for improving the control of other chronic diseases as well.</p><p>Trial registration</p><p>This study is registered at clinicaltrials.gov, <a href="https://clinicaltrials.gov/ct2/show/NCT00921401" target="_blank">NCT00921401</a>, “Improving the Quality of Asthma Care Using the Internet”</p></div

CONSORT.

<p>CONSORT.</p

Asthma control and quality of life outcomes based on the Asthma Control Test (ACT), National Asthma Survey (NAS) and National Asthma Education and Prevention Program (NAEPP).

<p>Asthma control and quality of life outcomes based on the Asthma Control Test (ACT), National Asthma Survey (NAS) and National Asthma Education and Prevention Program (NAEPP).</p

Baseline characteristics.

<p>Baseline characteristics.</p

Monthly intervention asthma questions.

<p>Monthly intervention asthma questions.</p

Fidelity: Percentage of participants using intervention at least once in each month.

<p>Fidelity: Percentage of participants using intervention at least once in each month.</p

Sample guideline recommendations, rules and feedback.

<p>Sample guideline recommendations, rules and feedback.</p

Secondary outcomes: Asthma-related healthcare utilization or medication adherence, based on insurance claims.

<p>Secondary outcomes: Asthma-related healthcare utilization or medication adherence, based on insurance claims.</p